Med-Surg Floor Nursing

Ruby Vee, BSN · Aug 9, 2017

Hi everyone, I've got a burning question I'd like answered if possible.
I hear two totally different things about that first RN job out of nursing school. One side says "Try and get on a med-surg floor. Do that for a year and you can do anything!" The other side says "Don't delay your ambitions. Floor nursing is terrible and you can be an ER/ICU/NICU/whatever nurse right out of school!"
The latter opinion is mostly people I meet in real life, and the former I read mostly on the internet, but there are exceptions. So far in clinical I have actually loved my med-surg experiences, but I realize that I am not working and things would be different.
What do you guys think? I'm in Florida, Tampa Bay area if it matters.

The people you meet in real life -- are they mostly people you're meeting in the context of school? It matters. Try to talk to some of the nurses you meet outside of school -- your great aunt Betsy's partner, your SO's mother, your next door neighbor who comes home every morning at 8:30 wearing scrubs. Ask them what they think. In general, I think, you'll find that people who are in nursing school or fresh out of nursing school will say to go for the specialty right out of school. "I did it and I did fine!" Nurses who have been at it for a long time will be more likely to tell you to get some experience in Med-Surg before going for the specialty.

I've been at it for a long time, and started in Med/Surg/Tele. I got the chance to see patients with a wide variety of disease processes, so I got broad experience. I learned a lot in those first two years: how to talk to patients, families, physicians, pharmacists and the hospital that transferred the patient to us. I learned how to walk into a room and do a mini-assessment in 1-2 minutes while introducing myself and announcing that I'd be back later after I'd read through the orders. I learned to place a Foley, NG, and IV while doing a full assessment and fielding questions about my other patients. I learned time management, organization and critical thinking stuff. I also learned that stuff with the heart fascinated me, neuro stuff bored me and GI bleeds grossed me out. I learned that I liked complicated patients, "walkie talkies" weren't my favorite patients and spending the whole shift with one group of patients rather than lots of admissions and discharges was more comfortable for me. I wouldn't have learned those things had I not started where I did. When I did jump into a specialty (MICU/CCU), I didn't have to learn the basics. I just had to learn the specialty stuff, the specialty drugs, the specialty providers. I had the opportunity to learn and understand the specialty stuff thoroughly because I wasn't also learning the basics at the same time.

My husband, who has been a nurse since the early 80s, observes that the people who start out in specialties don't last as long. They burn out faster and leave nursing earlier. He also points out that when someone says they started directly in a specialty, that they managed just fine and they're an awesome nurse, it might be interesting to see what their colleagues have to say about all of that. (I'll add "and their preceptors." ) Some genuinely do manage just fine, that is true. But not as many as think they do.

The_Muffintime · Aug 9, 2017

The people you meet in real life -- are they mostly people you're meeting in the context of school? It matters. Try to talk to some of the nurses you meet outside of school -- your great aunt Betsy's partner, your SO's mother, your next door neighbor who comes home every morning at 8:30 wearing scrubs. Ask them what they think. In general, I think, you'll find that people who are in nursing school or fresh out of nursing school will say to go for the specialty right out of school. "I did it and I did fine!" Nurses who have been at it for a long time will be more likely to tell you to get some experience in Med-Surg before going for the specialty.
I've been at it for a long time, and started in Med/Surg/Tele. I got the chance to see patients with a wide variety of disease processes, so I got broad experience. I learned a lot in those first two years: how to talk to patients, families, physicians, pharmacists and the hospital that transferred the patient to us. I learned how to walk into a room and do a mini-assessment in 1-2 minutes while introducing myself and announcing that I'd be back later after I'd read through the orders. I learned to place a Foley, NG, and IV while doing a full assessment and fielding questions about my other patients. I learned time management, organization and critical thinking stuff. I also learned that stuff with the heart fascinated me, neuro stuff bored me and GI bleeds grossed me out. I learned that I liked complicated patients, "walkie talkies" weren't my favorite patients and spending the whole shift with one group of patients rather than lots of admissions and discharges was more comfortable for me. I wouldn't have learned those things had I not started where I did. When I did jump into a specialty (MICU/CCU), I didn't have to learn the basics. I just had to learn the specialty stuff, the specialty drugs, the specialty providers. I had the opportunity to learn and understand the specialty stuff thoroughly because I wasn't also learning the basics at the same time.
My husband, who has been a nurse since the early 80s, observes that the people who start out in specialties don't last as long. They burn out faster and leave nursing earlier. He also points out that when someone says they started directly in a specialty, that they managed just fine and they're an awesome nurse, it might be interesting to see what their colleagues have to say about all of that. (I'll add "and their preceptors." ) Some genuinely do manage just fine, that is true. But not as many as think they do.

Great advice, Ruby! For the record, the people I was talking about who say skip the floor have largely been new RNs I've met at clinical on psych units, Endo, and ER. There are a few others.

You hit the nail right on the head with what you said about experienced nurses. My instructors with whom I've talked about this and one other experienced CCU nurse are basically the only ones telling me not to skip the floor.

I'm wont to trust their perspective, as well as yours, Ruby.

Checkers08, BSN, MSN, RN · Aug 10, 2017

I went straight into ER with 5 other new grads, and only 2 of us made it past 1 year. I know there is a LOT of knowledge and experience to be gained in floor nursing, and I don't think it's terrible by any means. I tremendously enjoyed my med-surg clinicals in school, but the offer I got for the ER worked out better for my circumstances at the time. My best recommendation if you do decide to go for a specialty is to find out everything you can about the orientation process and make sure it will be as effective as possible for you. I was very fortunate in mine in that it lasted about 6 months with weekly classes in addition to our time on the floor. Ask as many questions as you can think of, and talk to as many people as you can.

Career Columnist / Author · Aug 13, 2017

What Ruby Vee said :)

I think you can go either way....but for me, starting on MedSurg was invaluable. It's almost become unpopular to advocate for the basic nursing skills acquired in MedSurg.

I'll never forget working ICU alongside a new grad who got an order to irrigate a foley catheter...but had never done it. It was almost a cognitve dissonance for me- an ICU nurse without basic and common experience. But that's just me and my opinion.

NightDiva2k · Aug 13, 2017

A new grad starting in a Specialty needs to seek one of the longer orientation programs. Some hospitals use Versant, another is StaRN. This gives you a team of experienced nurses going thru a lengthened orientation - covering the basics before handing you off to trained preceptors at your facility. This type orientation is hospital driven, you may be able to see which facilities are doing this. Otherwise, for what it's worth, my 4 years MedSurg prepared me to be a more multitalented ICU/ICU Travel RN for the next 19+ years.

Mavrick, BSN, RN · Aug 14, 2017

Ending up in a specialty you like right off the bat is a matter of luck. You don't really know what you like 'til you get in there. Familiarity with the specialty from TV shows don't cut it. Then, by the time you figure out you don't like it or are just not competent you are no longer a new grad and expectations are much higher. You don't get the thorough orientation you really need because you're already a nurse and "should" know.

I knew I didn't want to BE a floor nurse but I worked the floor for a year and sure learned to APPRECIATE the floor nurse. Time management and prioritization are invaluable skills that will always serve you well.

I was right about loving Critical Care though. Once I left the floor I NEVER looked back!

llg, PhD, RN · Aug 18, 2017

I think it depends on the person and on the specific specialty of interest. It also depends on how the person feels about caring for adults. There is no "one size fits all" career path.

Had I been forced to work adult med/surg as a new grad, I would have gone to law school. It is simply a type of nursing that I have never been interested in -- and it is a field that does NOT prepare a person to my clinical love, NICU nursing. One of the most difficult types of people to orient to NICU is someone with an adult med/surg background. It is not a good training ground for a future NICU nurse (though of course, a few people have successfully transition from adult med/surg to NICU).

I would say that in general, adult med/surg is not particularly advantageous to any peds specialty. If a new grad really wants a career in peds or NICU, there is no advantage in doing adult med/surg first -- thought I think a peds med/surg is a good preparation for peds ICU, peds ED, or peds surgery, etc.

If you like adult med/surg and want to work with adult patients, adult med/surg can be a great place to start a nursing career. But it is not the best choice for everyone.

lovingtheunloved, ASN, RN · Aug 21, 2017

I went from LTC to home health to crit care to pulmonary, and holy smokes, was it ever hard to transition into the hospital. Ten years ago I would have argued that you don't need med-surg, but older and wiser me realizes that life would have been tremendously easier had I had that background.

ThePrincessBride, MSN, RN, NP · Aug 21, 2017

I can answer this.

I wanted to start my career off in NICU but ended up on an adult med-surg floor. I was very upset I didn't get into NICU. But now that I have entered my third year of practice, I can say that I am glad I have med-surg experience. And unlike most people, I kept my med-surg job as a prn gig.

People who start off in specialties may have a great career and enjoy their work, but they may also be shooting themselves in the foot later on. There are so many NICU nurses on my unit with zero adult bedside experience who are going for FNP that it is scary. Many will struggle finding a job as a lot of employers in our area want three to five years of relevant acute care experience.

Also, they are at the mercy of our census in terms of paycheck unless they have a PRN job in another NICU (and those positions are few and far between).Meanwhile, those of us with med-surg experience are easily able to get hours elsewhere and have more flexibility.

But...I think it depends. Med-surg isn't absolutely necessary to succeed but it provides incredible range and variety one won't get elsewhere (except ED).